


ASSESSMENT MEETING  MULTIDISCIPLINARY MEDICAL TEAM (MEMORIAL) /  EXPERTISE TEAM (BCPRC)

by Jacqueline_64



Series: The Post Gunther Sessions [9]
Category: Starsky & Hutch
Genre: BCPRC, Gen, Not Beta Read, Post-Episode: s04e22 Sweet Revenge, Psychology, Rehabilitation, Serious Injuries, Trauma, assessment, memorial, therapy strategy
Language: English
Status: Completed
Published: 2020-02-01
Updated: 2020-02-01
Packaged: 2021-02-27 19:33:57
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 4,754
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/22511044
Author URL: https://archiveofourown.org/users/Jacqueline_64/pseuds/Jacqueline_64
Summary: The treating team of Memorial Hospital discusses the therapy strategy for the next phase of Starsky's rehabilitation with Bay City Physical Rehabilitation Center's expert team.
Series: The Post Gunther Sessions [9]
Series URL: https://archiveofourown.org/series/1534526
Kudos: 8





	ASSESSMENT MEETING  MULTIDISCIPLINARY MEDICAL TEAM (MEMORIAL) /  EXPERTISE TEAM (BCPRC)

The most used disclaimer:  
The TV show "Starsky and Hutch", and the characters from it  
are the property of the persons who hold the copyrights  
and other legal rights to them.  
This story is a work of fiction, written for pleasure only  
and not for profit. It is not intended, in any way,  
to infringe on these preexisting copyrights.

# THE POST GUNTHER SESSIONS

## ASSESSMENT MEETING  
MULTIDISCIPLINARY MEDICAL TEAM (MEMORIAL)  
EXPERTISE TEAM (BCPRC)

### RE: DET. DAVID MICHAEL STARSKY,

**June 25, 1979 – 5:15 PM, Memorial**

Jacqueline©2020-01-31

**HISTORY  
Patient:** |  |    
David Michael Starsky, white male, age 32  
---|---|---  
**Date of admission:** |  | May 15, 1979 - 1:50 PM; time of incident: approx. 1:08 PM  
**Category:** |  | Multi-trauma and Injury; Penetrating injuries to trunk: 3 gunshot wounds (GSW); suspected trauma to spinal cord;  
severe (internal) bleeding/suspected arterial haemorrhage; weak / irregular pulse; respiratory distress; unconscious.  
**ER:** |  | Trauma staff worked to stabilize the patient until finally at 2:45 PM he could be transferred to the OR for surgery.  
**OR:** |  | Trauma surgery team (OTT 4) – 9 hrs, 17 minutes; 3 bullets removed; 10 pints of blood; cardiac arrest after 4 hrs  
and 12 minutes; thoracotomy; resuscitation 7 minutes; cont. surgery.  
**Post-op status:** |  | Critical; comatose;  
|  |   
May 16, 1979 03:21 PM: |  | Cardiac arrest resuscitation 14 minutes.  
May 17, 1979 08.30 PM: |  | Downgraded to serious/guarded  
May 18, 1979 09:20 AM: |  | Off ventilator; nasal canula – status coma unchanged until 08:05 AM: patient conscious  
May 19, 1979 07:56 AM: |  | Patient awake – cognitive ability could not be tested yet  
May 20, 1979 11:05 AM: |  | Level 1 cognitive ability test; failed  
May 21, 1979 08:45 AM: |  | Level 1 cognitive ability test: successful  
May 22, 1979 10:15 AM: |  | Cognitive skills: adequate (non verbal); short term memory: unsatisfactory  
May 23, 1979 09:45 AM: |  | Level 2 cognitive ability test: failed; respiratory infection  
May 24, 1979 08:15 AM: |  | Respiratory infection; intravenous antibiotics; decision pending on putting patient on ventilator again.  
May 25, 1979 08.15 AM: |  | Restless night; fever spiking at 104 degrees; upgrade intravenous antibiotics; patient sedated  
May 26, 1979 08.15 AM: |  | Situation unchanged  
May 27, 1979 08.15 AM: |  | Slight improvement; fever down to 100 degrees  
May 28, 1979 08.15 AM: |  | Patient’s temperature down to normal level; sedation level reduced  
May 29, 1979 09:15 AM: |  | Patient off sedation, temperature normal, first psychological assessment cancelled  
May 30, 1979 10:05 AM: |  | Situation unchanged; introduction gelatin; special attention swallowing  
May 31, 1979 09:30 AM: |  | Note nursing staff regarding development of bedsores; special attention/treatment plan  
June 01, 1979 10:30 AM: |  | Wound care pressure ulcer started  
June 02, 1979 08:15 AM: |  | Patient transferred to high care unit; special matress, wound care cont’d.  
June 03, 1979 05:30 PM: |  | Introduction applesauce; nausea (admin. Prochlorperazine)  
June 04, 1979 08:30 AM: |  | Breakfast gelatin first success after swallowing training; spontaneous breathing trial (STB) started to wean patient  
off cannula – 20% reduction oxygen level after 30 minute trial; SB moments will be increased by 10 minutes each  
day with 2 hour breaks; monitoring (Sarge/Kramer alternating)  
June 05, 1979 12:30 PM:  |  | Pressure ulcer responding well to treatment; patient cognitive test level 3 successful; oatmeal/gelatin lunch, soft  
fruit: tolerated.  
June 06, 1979 09:30 AM:  |  | Patient’s bed raised 15 degrees; monitoring Colley/Aaronson subsequent consultation Jamison (head of trauma 1,  
critical care, physiatrist)/Aaronson (physical therapist) re therapy plan;   
June 07, 1979 10:15 AM:  |  | Pulmonary testing postponed in light of after effects of injury and surgery; STB continued: additional 15%  
reduction oxygen level (time intervals unchanged, Colley/Frantz alternating) pressure ulcer 80% healed;  
yoghurt: tolerated   
June 08, 1979 10:05 AM:  |  | Muscle strength/ROM testing (Aaronson, passive – assisted - mobilization protocol / muscle stretching protocol  
started); soft food / mash food diet started 3x/day; patient ready for first psychological assessment (Jamison /  
Johanson)   
June 09,1979 08:30 AM:  |  | Patient’s bed raised additional 15 degrees; monitoring Colley/Aaronson subsequent consultation P(a)MP;   
June 10, 1979 10:05 AM:  |  | Pulmonary testing successful (level 2), STB longer interfalls, oxygen reduction unchanged; P(a)MP   
June 11, 1979 11:15 AM:  |  | First psychological assessment (Johanson – advice for follow-up Jamison/Aaronson); additional 20% reduction  
oxygen level (time intervals unchanged, Sarge/Kramer alternating), patient’s bed raised additional 15 degrees  
(monitoring Colley)   
June 12, 1979 08:30 PM:  |  | Patient white blood count elevated: bladder infection, oral antibiotics started; 103 degrees; can’t keep food down;  
special attention; switch to intravenous antibiotics for night   
June 13, 1979 10:15 AM:  |  | Patient temperature unchanged; gelatin tolerated; extra fluids cont’d; 24 hr alert   
June 14, 1979 09:15 AM:  |  | Patient’s temperature normal; white blood count normal; mash food re-started (optional Prochlorperazine)   
June 15, 1979 02:30 PM:  |  | Last day intravenous antibiotics; breakfast: mashed bananas on ½ toast – tolerated; P(a)MP/ROM & muscle stretching  
cont’d.   
June 16, 1979 03:45 PM:  |  | Patient’s bed elevation 90 degrees total; exercise regimen expanded – standing up (20 sec each time – 5 min  
intervals); strengthening exercises extremities expanded; pulmonary testing level 4 successful.   
June 17, 1979 07:50 PM:  |  | Patient spent majority of day in (semi-)seated position; all read-outs (BP/HR/O2sat) normal; breakfast: toast+  
mashed banana, yoghurt; lunch: broth/toast; dinner: mash (potato/chicken/ Apple sauce)  
June 18, 1979 02:20 PM:  |  | P(a)MP/ROM & muscle stretching/ standing up (30 sec each time – 5 min intervals), strengthening exercises  
extremities cont’d.   
June 19, 1979 08:50 PM:  |  | Patient transfer to wheelchair practiced; time in wheelchair 5 min; readouts elevated; returned to normal after 4 min.  
43 sec.; motor development test: negative; consultation Aaronson/Foretti/Jamison exercise plan   
June 20, 1979 09:20 AM:  |  | Wheelchair transfer + seat. time in wheelchair 5 min., readouts elevated; returned to normal after 4 min. 02 sec.;  
P(a)MP/ROM & muscle stretching/ standing up (45 sec each time – 5 min intervals), strengthening exercises  
extremities cont’d.   
June 21, 1979 04:50 PM:  |  | PT exercises expanded; readouts: cont’d improvement; pulmonary test level 5 successful   
June 22, 1979 03:30 PM:  |  | PT exercises: on weekends will be continued as on weekdays (as in full sessions per instructions Aaronson/Foretti);  
P(a)MP/ROM continued, standing extended. Last drain removed; bandage/ wound care instructions (team B)   
June 23, 1979 06:15 PM:  |  | PT, P(a)MP/ROM continued, patient spent majority of day in seated position. Breakfast: toast+cheese and jelly; lunch:  
broth/toast with boiled egg, ½ apple; dinner: baked potato/boiled chicken/steamed vegetables (carrots/green beans)   
June 24, 1979 06:30 PM:  |  | PT, P(a)MP/ROM continued, patient spent majority of day in seated position.   
  
**June 25, 1979 – 5:15 PM, Memorial (transcript from recording)  
  
**

Attending for Memorial: Dr Richard Jamison (head of trauma 1, critical care, physiatrist)  
Moses Aaronson, PT, MS, Cert. MDT (physical therapist)  
Dr Frank Foretti (neurologist)  
Dr Elizabeth Cavanaugh (pulmonologist)  
Myrna Johanson, Ph.D. (psychologist)  
  
Attending for Bay City Physical Rehabilitation Center (BCPRC):  
Dr Sven Lindqvist (BCPRC head physiatrist/consultant)  
Dr Kevin Wallis (BCPRC, physical therapist - spinal)  
Dr Alice Cummings (BCPRC, occupational therapist)  
Dr Tom Olson (BCPRC, physical therapist - neurological)  
Dr Wendell Ingram (BCPRC, psychologist)

  
**Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Thank you, Dr Lindqvist and your team, for your time and effort today to evaluate our patient Detective David Starsky in order to establish a) his current condition, b) an estimation on his prognosis for his ultimate recuperation c) how to optimize the chances to accomplish this by means of a rehabilitation therapy strategy and treatment plan and d) what type of care or rehabilitation facility would be best equipped to give Detective Starsky the best chances on as complete a recovery as possible. To this end we had our first contact on June 18, during which you were informed on this particular case history from the day of the incident on May 15 until June 17. I would like to ask you and your team members to share your impressions of today’s assessment of our patient.

 **Lindqvist (BCPRC, head physiatrist/consultant):**  
Yes, thank you, Dr Jamison. Per your request I conducted the assessment with a team consisting of those specialists that most likely would be involved in a rehabilitation case such as of patient Starsky. As you know, the BCPRC has a highly acclaimed reputation in the field of rehabilitation therapy and our therapists are some of nation’s best in their expertise. We started our assessment with Detective Starsky at 10 this morning, each session taking a maximum of 30 minutes, including rest or recovery intervals. I will now give you our findings after which we can discuss them, if that is alright with you?

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Of course, please do.

 **Lindqvist (BCPRC, head physiatrist/consultant):**  
Thank you. First of all, after having read the complete history of this particular patient, the injuries he sustained on May 15, the amount of trauma from injuries as well as - especially - the emergency treatment directly following the incident, we can only conclude that it is nothing short of a miracle that Detective Starsky has come this far. My team and I commend Memorial, you and your team for their efforts that have not only kept him alive, but have had him regain so much functionality already.  
That is truly remarkable.  
And remarkable is a word that each of us has used often, today. Detective Starsky is, one cannot put it any other way, a remarkable young man. Doctors Cummings and Ingram used this word to describe him after their individual and shared contact with Detective Starsky. To them, he seemed very level headed and realistic, if perhaps a tad too optimistic, about his situation. However, we – as we shared our impressions to come to this evaluation as a team – feel that his realism is truly balancing out his optimism. It is clear he has been injured before. Perhaps not as seriously as this last time, but he – as he himself put it – “knows the drill” and realizes, as he also himself volunteered to tell us, that it is often a case of 2 steps forward, 3 steps back. Combined with his sense of optimism and realism, his inner strength is another asset that makes for an almost ideal mix.  
So, as far as our team’s combined impressions go, the psychological assessment of Detective Starsky is positive. He is mentally strong and his determination, realism and optimism, although perhaps a tad too strong, are very important, if not ideal characteristics to have in a situation such as his.  
Doctors Wallis and Olson examined and evaluated Detective Starsky’s physical condition and motor and neuron responses through the test that we have developed for new patients, to assess at what level their rehabilitation program should be set. It is obvious that Mr. Starsky’s biggest issues at this moment are of a predominantly physical nature. His mobility, dexterity and functionality overall are impaired by the damage the bullets caused to bones, muscles, vessels, nerves and tissue. Based on our findings of today’s tests we feel it is safe to conclude that these impairments do not have a neurological cause, but are – so to speak – purely the result of the internal physical damage and subsequent healing process.  
So, based on these results and our study of his case file, his X-rays, his body scans, the results of the various physical and neurological tests and examinations Memorial has performed on Mr. Starsky, we can rule out that any of his physical impairments stem from presumed neurological damage he might have suffered during his cardiac arrests or coma, as indeed Dr Foretti had already concluded in his notes. Now, for more details on the individual assessments I would like to ask my team members to share their findings….. Dr Olson…… Tom, would you like to begin?

 **Dr Tom Olson (BCPRC, physical therapist - neurological):**  
Sure, although there is not much more left to say. Uhm, as Dr Lindqvist just mentioned, we did study Detective Starsky’s medical history since May 15 beforehand and from reading that I halfway already arrived at the same conclusion as Dr Foretti. Today’s tests went well in that I found patient’s impairments to not be caused by neurological damage. As you know, neurological assessment focuses on the nervous system to assess and identify any abnormalities that affect function and activities of daily living. It is obvious that Mr Starsky at the moment has problems performing the most simple, daily, actions however his physical abilities are hampered because of the location and character of his injuries, not because of any damage on a neurological level. The neurological control is unaffected and functions at a normal level. The impairments are simply mechanic in nature due to the internal injuries, the bruising, the swelling and also the inactivity when patient was in coma or sedated. Therefore our conclusion is that we see no need for a neurologically based physical therapy program for Mr. Starsky. Kevin? Dr Wallis…..

 **Dr Kevin Wallis (BCPRC, physical therapist - spinal):**  
Yes, thanks. Like Dr Olson, I too did the tests for my expertise, which is physical therapy for injuries of and around the spinal cord – the spinal area and uhm, as you may guess from what he just mentioned regarding the functioning of the nervous system, my findings are similar to those of Dr Olson, so we arrived at the same conclusion. The bullets indeed impacted Mr Starsky’s upper body in and around the spinal area, but the spine, nor the thoracic vertebrae and nerves, the peripheral nerves, nor the muscles in the immediate area were catastrophically hit by the bullets. By that I mean that none of them were severed or damaged beyond repair. The ER and Trauma Surgery teams have done an outstanding job in repairing the considerable damage. The initial suspicion of spinal damage fortunately was a false positive caused by a considerable amount of bruising in the affected area. The spinal cord and all connecting nerves and muscles were not struck and the hampered functionality was and is not permanent. His latest scans and X-rays show some residual fluids, scar tissue and after effects of the bruising, but non of it affects the spine or any of the major nerves, muscles or vessels. He does have problems with his fine motor skills, but they are non symptomatic for neurological or spinal injuries and seem more a result of the after effects of the bruising of the spine and spinal area due to the impact of the bullets and of course the obvious damage done to his right scapula and lesser damage to his scapulothoracic joint. So, we expect that this will improve with time and therapy. On a personal note I have to say that if a person is so unfortunate to receive bullet wounds in this delicate and vulnerable area of the human body, this is the most fortunate outcome. Mr Starsky had a guardian angel on his shoulder – no pun intended - on May 15. Therefore Mr Starsky does not need to follow a spinal injury specific physical therapy program. Who’s next?

 **Dr Alice Cummings (BCPRC, occupational therapist):**  
Shall I? I sat in on both sessions of doctors Wallis and Olson to observe Detective Starsky’s level of physical ability at this point. It is obvious that right now, Mr Starsky is not able to do much himself. Taking into consideration what he has endured and how long ago he was admitted to hospital that was to be expected. But I was actually quite surprised to read that Detective Starsky is already in the early stages of mobility exercises and is spending most of his days in a seated position. That is truly remarkable. My assessment is that he will need daily therapy sessions, perhaps more than one per day, with emphasis on his fine motor skills, muscle regeneration, rotation and flexibility and equilibrium restoration. We did notice he is experiencing some problems in that area, too.

 **Dr Tom Olson (BCPRC, physical therapist - neurological):**  
Yes, that’s right, but like Dr Wallis mentioned earlier, his equilibrium issues are also non symptomatic for neurological damage. Perhaps there is an unrelated cause…. Unrelated to the shooting, I mean. Maybe an ENT should examine his ears to see if there is something there that causes his instability. Excuse me, Dr Cummings…..

 **Dr Alice Cummings (BCPRC, occupational therapist):**  
No, I was going to ask your input on that anyway (note: laughter). So, physical therapy sessions, possibly more than one on a daily basis and occupational therapy to help him regain independence. Wendell?

 **Dr Wendell Ingram (BCPRC, psychologist):**  
Thank you. Yes, as Dr Lindqvist said at the beginning, Mr. Starsky is – uh, detective Starsky is a remarkable young man. Very resilient. From his medical file and background assessment by Dr Johanson I learned he has had his share of hardship, both physical and mental, pretty much throughout his entire life. Silly as that may sound: it builds character. Both Dr Cummings and myself have had individual interviews with him today and one together, all in between the physical tests executed by the other team members. I agree with Dr Johanson’s note that Mr Starsky’s optimism can be of great help in his recuperation, but can also pose a danger for that same recuperation. For now, I feel that it works in his favor. He’s exceeding expectations every day, but is aware that there is a very thin line between the positive effects and tipping the scale to risking setbacks. I do feel Mr Starsky is an emotional and intuitive person and therefore it is very important how and where his rehabilitation will take place. My impression is that his patience is already running low regarding his current situation, as in being “stuck” in a hospital room 90 percent of his time – those were his literal words; I can see that is no news to you (note: laughter ) – while clinically speaking, Mr Starsky was dead for a short while a mere 6 weeks ago. You, Dr Jamison and Dr Lindqvist, are in a better postion to estimate how much more time is needed for Detective Starsky to be able to leave the hospital for the next phase of his rehabilitation. But Dr Cummings and myself have come to the conclusion that a move to yet another medical facility, which in the underlying case would be a rehabilitation center such as the BCPRC, might not produce the desired outcome or expected prognosis. Now, we do understand that in cases such as Mr Starsky’s, feelings and outlooks that patients have can vary from day to day. But as we assess him at this moment, we think that once he will be well enough, medically, to start the next phase, he will probably fare better in a non medical environment than at a care facility or institution. Perhaps Dr Lindqvist can elaborate?

 **Lindqvist (BCPRC, head physiatrist/consultant):**  
Shall I do that or should our teams discuss the strategy now?

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
I think we can combine the two, right? As soon as something comes up, from either side, we will include the Q&A immediately.

 **Lindqvist (BCPRC, head physiatrist/consultant):**  
Okay, so based on our findings today, this is a very A-typical case for various reasons. First of all, the timing and the degree of trauma. As Dr Ingram just mentioned, it is quite exceptional to be having a rehabilitation strategy meeting 6 weeks after the patient concerned was clinically dead for a short span of time. Then there are the discrepancies between the character of the impairments and the, wrongly, suspected causes, such as his impaired fine motor skills and equilibrium issues that do not stem from neurological or spinal damage. And lastly, but probably most importantly, the fact that we are dealing with a patient with a strong and emotional character. We suspect the term “mind over matter” qualifies him, to a high degree. In that regard, as Dr Ingram also said, it is very important that his feelings and his emotional state are taken very seriously as we feel that they control his physical wellbeing. In other words, we feel that even if on paper, in a rehabilitation strategy plan, the best results for his recuperation will be achieved at an official care facility, his adversion to that prospect will bare a negative influence on his physical wellbeing and thereby, unconsciously, will sabotage his chances for as full a recovery as possible.

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Well, ….. you feel this really that strongly?

 **Dr Wendell Ingram (BCPRC, psychologist):**  
We do.

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Thank you, all, for your evaluation of Detective Starsky. I think I can speak for our team that this not a big surprise to us. As you know, this case is …….. has become, very special to us for the reasons you’ve mentioned. 6 weeks ago, planning a rehabilitation strategy plan was not on anyone’s mind as a possibilty for this patient, and yet, here we are today. And speaking of emotions: the alternating team members who have been involved with Detective Starsky’s case have invested much of themselves in his care and have become quite emotionally involved as well. It is no overstatement to label this case as medically historic. Let us give some first reactions to the conclusions of Dr Lindqvist’s team. Would you like to start, Frank?

 **Dr Frank Foretti (Memorial, neurologist):**  
Thanks, Richard. No, no surprises here. As far as his false neurological issues go, the neurological department and Dr Yang’s team for spinal injuries, have come to the same conclusions as your team. That they are mostly caused by the bruising in the spinal area and are therefore expected to be temporary. We all know that the duration of such after effects is different for each individual and statistics show that there is also always a percentage of patients who will not recover their abilities for the full 100%. We will, of course, continue monitoring and testing Detective Starsky during his stay in Memorial and later, if necessary, as an out-patient. I do agree, based on what we’ve experienced with patient so far, that he can certainly will himself to achieve certain things, even when one would think them to be impossible for him at that particular point in his recuperation.

 **Dr Elizabeth Cavanaugh (Memorial, pulmonologist):**  
Agreed. The only irreparable permanent physical damage is the removal of one third of patient’s right lung at the middle and inferior internal level. Incredibly, the bullet’s trajectory and velocity somehow only caused relatively minor damage to the pulmonary veins and the suspected arterial haemorrhage in that area was in fact a secondary tissue haemorrhage. Detective Starsky’s lung function will probably always be slightly below normal, but will not be obstructive to being able to live a functional, life. In fact, as you could read in his file, his lung function has improved by leaps and bounds especially in the past two weeks.

 **Myrna Johanson, Ph.D. (Memorial, psychologist):**  
I fully agree with doctors Ingram and Lindqvist regarding Detective Starsky’s personality, character and inner strength. The fact that he was in excellent physical condition before May 15 and that he indeed suffered massive physical damage that was, considering the weapon and ammunition that was used, less serious than what one would have expected, might lull us into thinking that he was lucky. As you could read in his medical file, I have always emphasized that patient’s optimism and personality may help him but may also harm him if he’s not moderated in his desire to recover as quickly as possible. I do agree, though, that having him admitted to another care facility for the next phase of his rehabilitation, might accelerate the onset of a depression, which – as we all know – always occurs in every patient, sooner or later during their recovery, once the reality of their new situation sinks in. So, we must decide on how and where Detective Starsky’s next phase of rehabilitiation will take place so it will benefit him most. Dr Aaronson and I have set up a preliminary physical therapy/psychological processing combination program that has already proven to be effective for Detective Starsky……

 **Moses Aaronson, PT, MS, Cert. MDT (Memorial, physical therapist):**  
Yes. Detective Starsky’s personality and character, combined with his age, his background and his occupation challenged us to craft a therapy program that would stimulate him, both mentally and physically. He is a practical man who is goal and result driven. Although he has a good sense of realism, he is also very impatient and motivated. As you can read in his file, Dr Johanson and myself, with input from Dr Jamison and even patient’s close circle – his mother, his partner and his captain – managed to compose a combo therapy program customized to Detective Starsky’s personality and physical abilities of the moment. I personally would like to hear your opinion about that program and approach.

 **Lindqvist (BCPRC, head physiatrist/consultant):  
**We think it is a very effective and easily adjustable regimen and its multi-disciplinary approach indeed seems to work for this patient. We could see the increase of responsiveness of his system in his file, as soon as the regimen was started.

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
So, what would your advice be regarding the next phase of Detective Starsky’s rehabilitation?

 **Lindqvist (BCPRC, head physiatrist/consultant):  
**In our opinion, Mr or Detective Starsky – once his physical condition has reached the level to enter the next phase of his rehabilitation – will benefit most from receiving treatment in familiar and relaxed settings. As we concluded before, none of his injuries – except for the removal of part of his lung – are structural or permanent and the impairments he is experiencing now, look to be caused by after effects that we mentioned before. None of the neuro or muscular memory is lost. The current impairment of functionality is – again – an after effect of trauma sustained and can be repaired and regained through extensive physical therapy. The type of physical therapy needed to improve Mr Starsky’s condition does not need any elaborate equipment that would be used for, say, patients with spinal cord injuries such as paralysis, be it partial or more extended, or stroke victims with a neurological disconnect. No parallel bars, no tilting tables, no orthotics or such. We advice to continue the current regimen with its progression schedule while Mr Starsky is still in hospital and, once his condition allows it, to let him go home or any location that is familiar and comfortable to him – of course allowing what lighter rehabilitation equipment or other medical devices such as perhaps an adjustable bed as long as he may need it, mobility aids etcetera to facilitate his ongoing therapy in those familiar surroundings. The three main objectives are the regaining of strength and dexterity and the recovery of control over his fine motor skills and do not necessarily require an in-patient status in a care facility.

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Well, I think it is safe to conclude that Mr. Starsky will be extremely pleased once he learns what you have recommended for his next rehabilitation phase (note: laughter). I noticed you did include a test and test schedule with documented criteria that will be helpful to establish if Mr. Starsky’s progress at any point during his program deviates from what might be expected, considering his injuries.

 **Lindqvist (BCPRC, head physiatrist/consultant)** :  
Yes, and we of the BCPRC are of course, at any time, willing to assist should your team feel that might be required. In the past we have assisted each other more than once with similar complex cases in assessing possibilities to achieve optimal results for a patient. And for members of the BCPD or other emergency or uniformed or military services, well, I think we all feel that is the least we can do as a token of appreciation for their services.

 **Jamison (Memorial, head of trauma 1, critical care, physiatrist):**  
Indeed. Well, if there are no more questions? Anybody? We will keep in touch with intermediary reports, as you suggested, follow your tests and criteria and continue the current program and progression schedule and we’ll take it from there. Thank you all for your time, your assessments and your input and expertise. After all the horror he has been through, Detective Starsky at the very least has a great team of motivated and expert professionals dedicated to helping him back on his feet


End file.
